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Hydrocephalus in children with ruptured cerebral arteriovenous malformation

Sarah Stricker1, Grégoire Boulouis1,2,3, Sandro Benichi1

  • 11APHP, Necker Hospital, Université de Paris.

Journal of Neurosurgery. Pediatrics
|May 23, 2020
PubMed

Insights

Nearly half of pediatric patients with ruptured brain arteriovenous malformations required external ventricular drainage (EVD). Low initial Glasgow Coma Scale and high modified Graeb Scale scores predict EVD need in pediatric hydrocephalus.

Area of Science:

  • Pediatric Neurosurgery
  • Neurological Outcomes
  • Cerebrovascular Diseases

Background:

  • Hydrocephalus significantly impacts neurological outcomes following intracerebral hemorrhage (ICH).
  • Ruptured brain arteriovenous malformations (bAVMs) are a primary cause of ICH in children.
  • Understanding hydrocephalus predictors in pediatric bAVM-related ICH is crucial for management.

Purpose of the Study:

  • To analyze the incidence and predictive factors of hydrocephalus requiring acute external ventricular drainage (EVD) or ventriculoperitoneal shunt (VPS) in pediatric patients with ruptured bAVMs.
  • To identify clinical and imaging predictors associated with the need for EVD or VPS placement.

Main Methods:

  • Retrospective analysis of a prospectively maintained database of pediatric patients with ruptured bAVMs admitted since 2002.
  • Inclusion of 114 pediatric patients with 125 distinct ICH events.
  • Statistical analysis using univariate and multivariate models to identify predictors of EVD and VPS placement.

Main Results:

  • 44% of hemorrhagic events required EVD, and 4.4% of patients ultimately needed a VPS.
  • Predictors for EVD included low initial Glasgow Coma Scale (iGCS) score, hydrocephalus on initial CT, intraventricular hemorrhage (IVH), and higher modified Graeb Scale (mGS) score (all p < 0.001).
  • Children requiring VPS had initial hydrocephalus necessitating EVD and higher mGS scores.

Conclusions:

  • Almost half of pediatric patients with ruptured bAVM-related ICH required EVD, with a small percentage needing a permanent VPS.
  • Low iGCS and high mGS scores are valuable indicators of IVH burden and aid in emergency decision-making.
  • These findings can help optimize treatment strategies for pediatric hydrocephalus secondary to ruptured bAVMs.
Abstract

Keywords:
arteriovenous malformationexternal ventricular drainhydrocephalusintracerebral hemorrhagevascular disordersventriculoperitoneal shunt

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